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* Better reflects current medical practice * Structure accommodates addition of new codes The current coding system is running out of capacity and cannot accommodate future state of health care * Benefit: More accurate payments for new procedures Fewer miscoded, rejected and improper reimbursed claims

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ICD-10-CM is similar to ICD-9- CM as far as format and basic guideline information * ICD-10 Basics Total number of codes expands from about 14,000 ICD-9-CM codes to well over 68,000 in ICD-10-CM (the majority of additions lie in the musculoskeletal codes, accounting for about 37,000 of the additional codes) ICD-10 Uses full code titles in the code description, while ICD-9 does not ICD-10-CM was designed with better capability for expansion

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ICD-10 Structure Example S52.5 Fracture of lower end of radius S52.52 Torus fracture of lower end of radius S52.521 Torus fracture of lower end of right radius S52.521A Torus fracture of lower end of right radius, initial encounter for closed fracture Code can’t be completed until all information as to type of fracture, site (lower end of radius), healing type and encounter are specified. S52 Fracture of forearm

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The number of codes has increased dramatically * What may have been a single code in ICD-9 may now have several hundred code choices due to the specificity of ICD-10-CM * Code choices require more information * More specificity may require better documentation

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* Fracture of Patella * 2 ICD-9 codes translate to a seemingly absurd number of ICD-10 Codes * But only 5 new documentation elements! It’s not about the thousands of new codes, it’s about the dozen or so new documentation elements!

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* Mild, Moderate, or Severe? * Intermittent or Persistent? * Tobacco use or exposure? If you create one of these for your top 50 most frequently used diagnoses, and introduce one every two weeks, you will be ready.

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“Physicians may be ICD-10 compliant, but if they abuse the “other” or “unspecified” codes, payment will not occur if a more specific alternative exists.” David Winkler Director of Technical Program Management Blue Cross of Michigan Justifying medically necessary procedures and services depends on specificity of diagnoses coding!